September 2004
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A Matter of Health
Prevention easier said than done
The mantra of the last half of this century has been prevention. Eat better and exercise more to prevent heart disease. Quit smoking or avoid it altogether, reduce your fat intake and know your carcinogens to prevent cancer. Immunize yourself and your children against infectious diseases. Avoid the risky behaviors that put you at risk for catching diseases.
Those are all good ideas. In fact, they are excellent ideas. However, none of them are 100 percent. In a world that looks for culprits and villains, it is often too easy to blame the victim, when it comes to disease.
When a friend of mine became ill with an infection recently, our friends besieged me with questions. Was it the doctor's fault? Should the friend have been aware of the infection early? Was there something the doctor did not do? Who was wrong?
My answer was pretty simple. No one was at fault. These things just happen, sometimes.
Of course, that answer is not complete or even accurate. These things just do happen sometimes, but there is a cause. We just do not know what it is. I wish we did.
Once, I overheard people talking about a woman who inexplicably had a very small baby. She carried the baby the full nine months. She had given up smoking years before she conceived. She was careful about her diet. She limited her traveling. She walked every night. She gained the recommended amount of weight. And yet, her baby weighed just over 4 pounds at birth.
"I wonder what she did wrong," one woman said.
She probably did nothing wrong. We do not always know why some women have small babies and others have large ones. Her small baby grew into a big strapping boy - brilliant, well-mannered and incredibly polite.
I wish we could prevent all the negative things that happen to people. Often, we find out too late that our actions are not good for us. Or we do not recognize a danger until it is too late.
None of this means that we should give up trying to prevent diseases. Scientists are now in the laboratory attempting to develop vaccines against AIDS and other deadly diseases. Constant work is ongoing in trying to understand how disease occurs and to develop measures to stop it.
It is important to be precise. Nothing proves that more conclusively than the hormone replacement therapy conundrum. Trying to prevent heart disease and other ailments, doctors put post-menopausal women on combinations of hormones that mimicked their pre-menopausal state. The evidence was circumstantial at best. And it did not work. Instead, women were exposed unnecessarily to the risks of the hormones without obtaining benefits.
One major issue is the law of unintended consequences. In preventing one disease, are we setting the stage for another? We must understand the diseases we seek to prevent and we must understand the consequences of preventing them.
More important, it is time to understand that not every disease can be
prevented - yet. And it's no one's fault.
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Prevention easier said than done |